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Medications for Glaucoma

There is no "cure" for glaucoma, but it can be controlled. Even when treatment is effective, people with glaucoma need to have their eyes checked regularly, and often need to continue treatment for the rest of their lives. This may seem like a burden, but is preferable to losing your sight.

Treatment for glaucoma focuses on lowering intraocular pressure (IOP) to a level the ophthalmologist thinks is unlikely to cause further optic nerve damage. This level is sometimes known as the "target pressure." (High IOP may damage your optic nerve, which can lead to vision loss.) That level differs from individual to individual, and one person's "target pressure" may change during the course of his or her lifetime.

Types of Medications

If you have open-angle glaucoma (the most common type) your ophthalmologist may prescribe medication to lower your intraocular pressure (IOP).

Medications may be topical, such as eye drops, inserts (wafer-like strips of medication you put in the corner of your eye) or eye ointments, or oral, such as pills or tablets.Topical medications reduce or control IOP in one of two ways:

Miotics increase the outflow of aqueous (liquid) from the eye. These include:

• Isopto®Carpine
• Ocusert®
• Pilocar®
• Pilopine®

Epinephrine compounds also increase the outflow of aqueous from the eye. These include:

• Epifrin®
• Propine®

Beta-blockers can reduce the amount of aqueous produced in the eye. These include:

• Betagan®
• Betimol®
• Betoptic®
• Ocupress®
• Optipranalol®
• Timoptic®

Carbonic anhydrase inhibitors and Alpha-Adrenergic Agonists also work to reduce the amount of aqueous the eye produces: These include:

• Alphagan®
• Iopidine®
• Trusopt®

In June, 1996, the U.S. Food and Drug Administration (FDA) approved a new glaucoma medication, latanoprost (Xalatan®), for treatment of glaucoma. This medication is in a group of drugs called prostaglandin analogs. It works near the drainage area of the eye to increase the secondary route of outflow aqueous outflow to lower IOP.

Oral medication can also help control IOP. The most common oral medications are carbonic anhydrase inhibitors, which work to slow production of aqueous fluid in the eye. These pills include Daranide®, Diamox® and Neptazane®.

The ophthalmologist may prescribe either topical or oral medication, or a combination of both. These may need to be taken several times a day in order to be effective.

Many of the same medications used to treat open-angle glaucoma are also used to treat angle-closure glaucoma.

This type of glaucoma can cause IOP to rise very quickly, and the ophthalmologist may need to lower the pressure rapidly to prevent vision loss. He or she may administer a sugar-based medication called a hyperosmotic agent either by mouth or by injection. This medication only lasts six to eight hours, so it is not used for long-term management of glaucoma.

Possible Side Effects

Any medication, including eye drops, may have side effects. Some people taking glaucoma medication may experience:

• Stinging or redness of eyes
• Blurred vision
• Headache
• Changes in pulse, heartbeat or breathing
• Changes in sexual desire
• Mood changes
• Tingling of fingers and toes
• Drowsiness
• Loss of appetite
• Change of iris color (in people with light-colored eyes taking prostaglandin analogs)

Most side effects aren't serious, and may disappear after a while. Not every patient will experience side effects with glaucoma medication. Since it is very important that people with glaucoma carefully follow their ophthalmologists' recommended treatments, any side effects of medication should be discussed with the doctor. If they become serious or intolerable, you and the ophthalmologist may decide to change medications or type of treatment.

Medication Tips

There are some things you should ask your ophthalmologist about your glaucoma medication:

• The name of the medication
• How to take it -- see How to Take Eye Drops -- with food or on an empty stomach
• How often to take it (if several times per day, should you take it "around the clock" or only during waking hours)
• How to store it (i.e., in the refrigerator or a dark place)
• If you can take it with your other medications (make sure all your doctors are aware of all the medications you take, including non-prescription medication)
• What side effects you might experience
• What you should do if you experience side effects
• What you should do if you miss a dose